title: Prevalence of diagnosed opioid abuse and its economic burden in the veterans health administration.
abstract: OBJECTIVE
  Evaluate prevalence and risk-adjusted healthcare costs of diagnosed opioid abuse in the national Veterans Health Administration (VHA). Costs were compared between patients with and without diagnosed opioid abuse.
  
  
  METHODS
  Medical and pharmacy claims analysis of VHA data (10/01/2006 to 09/30/2010) were retrospectively analyzed. Prevalence was calculated as the percent of patients with diagnosed opioid abuse for the entire VHA membership and those with noncancer pain diagnoses, compared between patients prescribed opioids prior to abuse diagnosis and those not prescribed opioids through the VHA system. Healthcare utilization and costs were estimated using matching techniques and generalized linear models to control for clinical and demographic differences between patients with and without diagnosed opioid abuse. Separate comparisons were made (with diagnosed abuse vs. without) for each cohort: patients with/without opioid prescriptions.
  
  
  RESULTS
  Five-year diagnosed opioid abuse was 1.11%. Among patients prescribed opioids, 5-year abuse prevalence was 3.04%. Pain patients prescribed opioids had the highest abuse rate at 3.26%. Adjusted annual healthcare costs for diagnosed opioid abuse patients were higher than for those without diagnosed abuse, (prescribed opioids overall healthcare costs: $28,882, with diagnosed abuse vs. $13,605 for those without; not prescribed opioids: $25,197 vs. $6350, P-value< 0.0001; opioid-specific healthcare costs for patients prescribed opioids: $8956 vs. $218; patients not prescribed opioids: $8733 vs. $20).
  
  
  CONCLUSIONS
  Diagnosed opioid abuse prevalence is almost 7-fold higher in the veteran's administration population than in commercial health plans and translates to a significant economic burden. Appropriate interventions should be considered to prevent and reduce opioid abuse.
authors.affiliation: STATinMED Research and The University of Michigan, Ann Arbor, Michigan, U.S.A.
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.forename: Lin
authors.initials: L
authors.lastname: Xie
authors.forename: Jack
authors.initials: J
authors.lastname: Mardekian
authors.forename: David
authors.initials: D
authors.lastname: Schaaf
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Ashish V
authors.initials: AV
authors.lastname: Joshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000191:economics*; D058014:Veterans Health / Q000191:economics*; D055815:Young Adult
keywords: economic burden; healthcare costs; opioid abuse; opioid dependence; veterans